More than 99% of infected people live in 31 African countries; the disease also exists in some foci in Latin America and Yemen.

Community-directed treatment with ivermectin is the core strategy to eliminate onchocerciasis in Africa; in the Americas the strategy is biannual large-scale treatment with ivermectin.

In September 2014 Ecuador became the second country in the world after Colombia in 2013 to be declared free of onchocerciasis after successfully implementing elimination activities for decades.

Onchocerciasis – or “river blindness” – is a parasitic disease caused by the filarial worm Onchocerca volvulus transmitted by repeated bites of infected blackflies (Simulium spp.). These blackflies breed in fast-flowing rivers and streams, mostly in remote villages located near fertile land where people rely on agriculture.

In the human body, the adult worms produce embryonic larvae (microfilariae) that migrate to the skin, eyes and other organs. When a female blackfly bites an infected person during a blood meal, it also ingests microfilariae which develop further in the blackfly and are then transmitted to the next human host during subsequent bites.

Signs and symptoms

Onchocerciasis is an eye and skin disease. Symptoms are caused by the microfilariae, which move around the human body in the subcutaneous tissue and induce intense inflammatory responses, especially when they die. Infected people may show symptoms such as severe itching and various skin lesions. In most cases, nodules develop under the skin. Some infected people develop eye lesions which can lead to visual impairment and permanent blindness.

Onchocerciasis is also found in some countries of Latin America: Brazil, Guatemala, Mexico and Venezuela (Bolivarian Republic of).

Prevention, control and elimination programmes

There is no vaccine or medication to prevent infection with O. volvulus.

Between 1974 and 2002, onchocerciasis was brought under control in West Africa through the work of the Onchocerciasis Control Programme (OCP), using mainly the spray of insecticides against blackfly larvae (vector control) by helicopters and airplanes. This was supplemented by large-scale distribution of ivermectin since 1989.

The OCP relieved 40 million people from infection, prevented blindness in 600 000 people, and ensured that 18 million children were born free from the threat of the disease and blindness. In addition, 25 million hectares of abandoned arable land were reclaimed for settlement and agricultural production, capable of feeding 17 million people annually.

In 1995, the African Programme for Onchocerciasis Control (APOC) was launched with the objective of controlling onchocerciasis in the remaining endemic countries in Africa. Its main strategy has been the establishment of self-sustaining community-directed treatment with ivermectin, and, where appropriate, vector control with environmentally-safe methods. Since 2009 APOC shifted from control to elimination of onchocerciasis.

In 2013, more than 100 million ivermectin treatments were distributed in 24 APOC countries where the strategy of community-directed treatment with ivermectin (CDTI) was being implemented, representing approximately 60% of the therapeutic coverage.

The Onchocerciasis Elimination Program of the Americas (OEPA) began in 1992 with the objective of eliminating ocular morbidity and transmission throughout the Americas by 2012 through biannual large-scale treatment with ivermectin. All 13 foci in this region achieved coverage of more than 85% in 2006, and transmission was interrupted in 10 out 13 by the end of 2011.

Following successful large-scale treatment of populations in affected areas with the support of international partners, Colombia and Ecuador were able to stop transmission of the disease in 2007 and 2009 respectively. Guatemala and Mexico were also able to stop transmission in 2011. Elimination efforts are now focused on the Yanomami people living in Brazil and Venezuela (Bolivarian Republic of).

On 5 April 2013, the Director-General of WHO issued an official letter confirming that Colombia has achieved elimination of onchocerciasis. The President of Colombia publicly announced this WHO verification in a ceremony held in Bogota on 29 July 2013. Colombia was the first country in the world to be verified and declared free of onchocerciasis by WHO. Subsequently, Ecuador was the second country to be declared free of river blindness on 29 September 2014.

Treatment

WHO recommends treating onchocerciasis with ivermectin at least once yearly for about 10 to 15 years. Where O. volvulus co-exists with Loa loa, another parasitic filarial worm that is endemic in Cameroon, the Central African Republic, the Congo, the Democratic Republic of the Congo, Nigeria and South Sudan, it is recommended to follow the Mectizan Expert Committee (MEC)/APOC recommendations for the management of severe adverse events that may occur.

WHO response

WHO is the executing agency of APOC. The WHO Regional Office for Africa supervises APOC’s management, while WHO headquarters provides administrative, technical and operational research support. Through the OEPA partnership, WHO collaborates with endemic countries and international partners.

WHO is currently facilitating the launch of an elimination programme in Yemen in collaboration with the Ministry of Health, the World Bank and other international partners.